SpineGuard, provider of DSG (Dynamic Surgical Guidance) sensing technology to secure and streamline the placement of bone implants, today announced new results reached in the development of its robotic application.
Spineguard’s DSG enabling technology is based on the local measurement of electrical conductivity of tissues in real time without X-ray imaging, with a sensor located at the tip of the drilling instrument. Its efficacy was proven by more than 90,000 surgeries across the globe and 24 scientific publications.
SpineGuard has entered in 2017 a collaboration with the ISIR (Institut des Systèmes Intelligents et de Robotique) lab of Sorbonne University, CNRS and INSERM, for the application of DSG to surgical robots and the enhancement of their safety, accuracy and autonomy as well as the optimization of the surgery workflow.
The experiment consists of automatically stopping the drill bit as the tip is aiming at the bone boundary during a vertebral drilling performed autonomously by a robot. However, in order to go further in the challenge and the demonstration of DSG efficacy, the trajectory is now pedicular. It presents tangential configurations perfectly matching delicate surgical situations where the spinal canal protecting the spinal cord must be avoided, and where the tip does not coast the bone surface in a perpendicular way. The algorithm used for the detection was tuned before the 50 drilling series was performed, and no adjustments or calibrations are needed for each specimen. The ex vivo pig vertebra validation model (butcher shop) does not involve any animal sacrifice.
100% of the drillings stopped within a corridor considered as clinically safe, which consists of 2 millimeters on each side of the interface between bone and the spinal canal. More precisely, all drillings belonged to a -0.9mm/+1.4mm interval, with a mean distance of 0.7mm. This was obtained although the drilling was performed in a totally “blind” manner, with neither utilization of pre-op nor intra-op imaging.
Pr. Roger Widmann, Chief of the Pediatric Orthopedic Surgery, Hospital for Special Surgery, New York, US, and Professor at Weill Cornell Medical College, adds: “Navigated DSG probes combine the safety and accuracy of surgical navigation with the additive value of DSG technology. DSG technology helps detect and avoid pedicle probe skive, pedicle breach and spinal canal violation. DSG technology provides added safety and accuracy in the setting of surgical navigation.”
Pr. Faheem Sandhu, Professor of Neurosurgery and Director of Spine Surgery, Georgetown University Hospital, US, completes: “The DSG technology has the potential of significantly improving safety during robotic screw placement in the spine.”
Dr. Richard Hynes, Director of The Back Center TBC in Melbourne, Florida, US, adds: “In the past, I have had great success with placement of screws via CBT and pedicle options using this impedance device. I am a true robotic enthusiast with extensive clinical experience in 3 varying robotic systems for the spine and sacroiliac joint. This technology facilitates our advance to even a higher level of robotic surgery eventually leading to precise and dependable decompression of delicate neural elements. I am truly excited about DSG robotic trajectory potential use for spinal applications.”
Pr. Richard Assaker, Professor of Neurosurgery at the University Hospital in Lille, France, concludes: “As a long-standing user of PediGuard devices, I have been practicing the robotic assistance in spine surgery for several months. The single technical frustration remains the control of drill bit skiving in pedicle canulation when the entry point is situated on an oblique bony surface. The idea of combining a technology that can detect the skiving and stop the pedicle drilling will increase my trust in robotic assistance particularly when it comes to percutaneous approaches.”